February 8, 2005

Brain-damaged patients may hear all

It looks like what Terri Schiavo's parents have been saying just could have been right all along! Just think what condition Terri could be in today if her husband Michael had not denied her therapy as the University of Chicago speech thereapy specialist suggested.

... Bernat said findings from studies like these would be relevant to
cases like that of Terri Schiavo, a Florida woman with brain damage who
has been kept alive for years against her husband's wishes. Her
relatives disagree about her condition, and a brain-imaging test could
help determine whether she has awareness.

... But researchers also recorded for each subject the voice of a
relative or loved one reminiscing. In the brain-damaged patients, the
voice prompted a pattern of brain activity similar to that of the
healthy participants.

... The two
men showed near-normal patterns in the language-processing areas of
their brains, Schiff said, suggesting that some neural networks "could
be perfectly preserved under some conditions."

- New York Times via Seatlepi.comThousands of brain-damaged people who are treated as if they are
almost completely unaware may in fact hear and register what is going
on around them but be unable to respond, a new brain imaging study
suggests.

The findings, if repeated in follow-up experiments, could have
sweeping implications for determining the best care for these patients.
Some experts said the study, which appeared yesterday in the journal
Neurology, could also have consequences for legal cases when parties
dispute the mental state of a patient who is unresponsive.

The research showed that brain-imaging technology could be a
powerful tool to help doctors and family members determine whether a
person had lost all awareness or was still somewhat mentally engaged,
experts said.

"This study gave me goose bumps, because it shows this possibility
of this profound isolation, that these people are there, that they've
been there all along, even though we've been treating them as if
they're not," said Dr. Joseph Fins, chief of medical ethics at New York
Presbyterian Hospital-Weill Cornell Center. Fins was not involved in
the study.

Other experts warned that the new research was more suggestive than
conclusive and did not mean that unresponsive people with brain damage
were more likely to recover or that treatment was yet possible.

But they said the study did open a window on a world that has been
neglected by medical inquiry. "This is an extremely important work, for
that reason alone," said Dr. James Bernat, a Dartmouth neurology
professor.

Bernat said findings from studies like these would be relevant to
cases like that of Terri Schiavo, a Florida woman with brain damage who
has been kept alive for years against her husband's wishes. Her
relatives disagree about her condition, and a brain-imaging test could
help determine whether she has awareness.

The patients in question have significant brain damage.

An estimated 100,000 to 300,000 Americans are in what is called a
minimally conscious state: They are bedridden, cannot communicate and
are unable to feed or care for themselves, but they typically breathe
on their own.

They may occasionally react to instructions to blink their eyes or
even reach for a glass, although such responses are unpredictable. By
observing behavior, neurologists can determine whether a person is
minimally conscious or in a "persistent vegetative state" -- without
awareness and almost certain not to recover.

In the study, a team of neuroscientists used imaging technology to
compare brain activity in two young men determined to be minimally
conscious with that of seven healthy men and women. In a measure of
overall brain activity, the minimally conscious men showed less than
half the activity of the others.

But researchers also recorded for each subject the voice of a
relative or loved one reminiscing. In the brain-damaged patients, the
voice prompted a pattern of brain activity similar to that of the
healthy participants.

"We assumed we would get some minimal response in these patients,
but nothing like this," said Dr. Nicholas Schiff, an assistant
professor of neurology and neuroscience at Weill Medical College of
Cornell University in Manhattan and the study's lead author. The two
men showed near-normal patterns in the language-processing areas of
their brains, Schiff said, suggesting that some neural networks "could
be perfectly preserved under some conditions."